Sunday, March 23, 2014

ACA/Obamacare Exemption Number Fourteen. True or False?

“Republican leaders are making preposterous assertions that President Obama has abandoned a centerpiece of his health care reforms — the requirement that most people obtain comprehensive health insurance or pay a penalty.In a cartoonish misrepresentation of how so-called hardship exemptions will be determined, the leaders, egged on by their allies in the conservative media, contend that recent steps by the Obama administration under-mine the individual mandate by giving virtually everyone who wants one a free pass to escape the penalty.These steps are modest midcourse corrections to deal with individual problems in the rollout of a large and complex program. As long as the state and federal officials in charge proceed judiciously, the public will benefit.The Republicans note, correctly, that some people may qualify for an exemption if their insurance was canceled and they can’t find affordable plans in the insurance market-places. But it’s not enough for applicants to simply say they cannot find an affordable policy; getting an exemption requires them to jump through all sorts of hoops. Besides submitting a copy of the cancellation notice, applicants must fill out a nine-page form, under penalty of perjury, that requires information for everyone in the family about income, employment and any job-related health insurance. In addition, there is no certainty that an application will be approved. That judgment of the applications will be made by the federal and state officials who run the marketplaces. We hope and expect that they will award exemptions judiciously, rejecting applicants who make willful efforts to evade the law and approving those who made good faith efforts to find affordable health insurance policies. Republicans also point to a catchall category that says that people may be eligible for an exemption if they “experienced another hardship in obtaining health insurance,” such as, perhaps, difficulty completing enrollment through balky websites.They must submit documentation “if possible.” But applicants who fail to document their case will only weaken their chances of getting an exemption. As always, the insurance exchange officials will make the final judgment and, we assume, reject specious claims.”- Health Care Caricature, New York Times, Editorial Board, 03/22/2014 (1)One must ask oneself: Is it indeed a caricature or is the assertion by Republicans accurate? To figure out the competing views one first needs to review a recent Wall Street Journal article: ObamaCare's Secret Mandate Exemption HHS quietly repeals the individual purchase rule for two more years, Wall Street Journal, 03/12/2014. Link to article appears directly below:

http://online.wsj.com/news/articles/SB10001424052702304250204579433312607325596#printModeWithin the Wall Street Journal article appears this passage:“This lax standard—no formula or hard test beyond a person's belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that "you experienced another hardship in obtaining health insurance," which only requires "documentation if possible." And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.”Looking into the passage above requires the following steps:(1) Department Of Health & Human Services, 12/19/2013Options Available for Consumers with Cancelled Policies http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/cancellation-consumer-options-12-19-2013.pdf(1a) Scroll down to “hardship exemption form” and click the hyper link which leads you to…….(2) Hardship Categories and Documentationhttp://marketplace.cms.gov/getofficialresources/publications-and-articles/hardship-exemption.pdf(2a) Now scroll down the form to hardship category #14. The fourteenth exemption category reads as follows: “You experienced another hardship in obtaining health insurance”. The required documentation for this particular hardship is described as: “Please submit documentation if possible.”If one views individuals as intelligent, self-interested and very creative it is not hard to conceive hardship case #14 being utilized to a great degree. Further, as exemption #14 becomes more widely disseminated information among individuals hardship case #14 will likely be utilized in a fashion of increasing at an increasing rate. Caricature or real information that can be utilized? Looks pretty real.Notes:(1) Health Care Caricature, New York Times, Editorial Board, 03/21/2014 http://www.nytimes.com/2014/03/22/opinion/health-care-caricature.html?hp&rref=opinion&_r=0

About Me

BS Economics, cum laude, Private and Public Sectors, 1979, West Virginia University, Morgantown, WV.
Undergraduate Minor in General Insurance.
Chartered Life Underwriter (CLU), Huebner School of Economics, American College, 1992, Bryn Mawr, PA.
Life Underwriter Training Fellow (LUTCF), 1986, National Association of Life Underwriters, Washington D.C..
Currently enrolled and completed one half of Chartered Property and Casualty Underwriter (CPCU) from the American College.
38 years insurance industry experience.